Comparison of PICU Cost and Severity-Adjusted Cost Between Patients With SIRS-Defined Sepsis and Those With Age-Adapted SOFA-Defined Sepsis
Open Access
- 25 February 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Pediatrics
Abstract
Background: The 2005 International Pediatric Sepsis Consensus definition is considered to lack specificity and may lead to the admission of low-risk patients to the pediatric intensive care unit (PICU). The aim of this study was to compare the PICU cost and the severity-adjusted cost between patients with sepsis defined by the 2005 International Pediatric Sepsis Consensus and those diagnosed using the age-adapted Sepsis-3 criteria. Methods: Septic children identified by the 2005 Consensus were screened for enrollment. The enrolled children were stratified into two subgroups using the age-adapted Sepsis 3.0 definition. A comparison was made between the subgroups of sepsis 3.0-defined children and non-sepsis 3.0-defined septic children. The Severity Adjusted ICU Cost (SAIC) was used to evaluate the case-mixed severity-adjusted costs of the study population. Coefficients in linear regression analyses in subgroups were calculated for presenting variation of PICU costs for every unit change of PRISM score. Results: A total of 397 children were enrolled. The PICU length of stay was longer in the sepsis 3.0 group than in the non-sepsis 3.0 group [median (IQR), 9.0 (5.0, 15.0) vs. 6.0 (3.0, 9.0); P < 0.001]. Pediatric risk of mortality (PRISM) scores and mortality were significantly higher in sepsis 3.0-defined septic patients. The total costs and daily costs in the PICU were both significantly lower in the non-sepsis 3.0 group (P < 0.001). The severity-adjusted ICU cost in the non-sepsis 3.0 group was lower than that in the sepsis 3.0 group [median (IQR), 7,125 (3,588, 11,134) vs. 9,364 (5,680, 15,876); P = 0.001]. There was no significant difference among the regression coefficients. Conclusions: The 2005 International Pediatric Sepsis Consensus definition does not lead to more PICU costs after considering illness severity. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03598127.Funding Information
- National Natural Science Foundation of China (81401606, 81400862)
This publication has 14 references indexed in Scilit:
- Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care UnitJAMA, 2017
- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)JAMA, 2016
- Systemic Inflammatory Response Syndrome Criteria in Defining Severe SepsisThe New England Journal of Medicine, 2015
- The Prevalence and Diagnostic Utility of Systemic Inflammatory Response Syndrome Vital Signs in a Pediatric Emergency DepartmentAcademic Emergency Medicine, 2015
- An Epidemiologic Survey of Pediatric Sepsis in Regional Hospitals in China*Pediatric Critical Care Medicine, 2014
- International comparison of the performance of the paediatric index of mortality (PIM) 2 score in two national data setsIntensive Care Medicine, 2012
- Pediatric Index of Mortality 2 score in Italy: a multicenter, prospective, observational studyIntensive Care Medicine, 2007
- Assessment and Optimization of Mortality Prediction Tools for Admissions to Pediatric Intensive Care in the United KingdomPEDIATRICS, 2006
- International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*Pediatric Critical Care Medicine, 2005
- Pediatric risk of mortality (PRISM) scoreCritical Care Medicine, 1988